Three Years After Katrina, Those Who Remain DisplacedReceive Little Help For Chronic And Mental Health Needs

Lengthy Stay In “Temporary” Government Trailers Has Outstripped Government Programs Focused On Short-Term Emergency Assistance

Bethesda, MD -- Three years after Hurricanes Katrina and Rita, tens of thousands of Gulf Coast households displaced by the storms still live in travel trailers provided by the Federal Emergency Management Agency (FEMA). These internally displaced persons (IDPs) suffer from high and worsening rates of depression and other chronic diseases, but they do not have adequate access to health insurance or medical care, according to a survey of Mississippi IDPs described in a Health Affairs Web Exclusive published today.

The survey, the first rigorous look at the health status of Katrina evacuees who remain displaced today, reveals a mismatch between a short-term emergency planning approach and the long-term health requirements of IDPs. “For the health needs of IDPs to be met, government (state and federal) and relief agencies need to ensure continuity of health coverage in the aftermath of a disaster, and develop long-term plans to address both chronic disease and mental health needs beyond the emergency response,” write authors Lynn Lawry, Nadine Shehab, and Michael Anastario.

During a two-week period in September 2007, the researchers interviewed members of a random sampling of the 17,789 IPD households living in FEMA travel trailer parks in Mississippi. Four-fifths of the respondents reported that at least one adult in their household had a chronic condition, and almost six in ten (58 percent) said the condition was getting worse. Fifty-eight percent of respondents reported that at least one child in the household had a chronic condition, and 68 percent of those respondents said it was getting worse.

Almost six in ten (57 percent) of the survey respondents met the criteria for major depressive disorder, and more than seven in ten (72 percent) reported symptoms of depression. “Even before Katrina, this was a vulnerable population, and their health needs have only gotten worse as their lives have been disrupted by years in ‘temporary’ FEMA housing,” said senior author Lawry, a senior health stability/humanitarian assistance specialist within the Office of the Assistant Secretary of Defense, Health Affairs.

Yet even as their needs have increased, the health resources available to the IDPs have decreased. Fewer than half (49 percent) of all respondents reported having health insurance -- a drop of ten percentage points from the 59 percent who had coverage before the storm. Loss or change of employment was the most common reason cited for losing coverage.

Significant numbers of respondents said they had delayed obtaining needed care for a household member; lack of coverage and insufficient funds were the primary reasons given for delaying care. For adult household members, 27.0 percent of respondents said they had delayed needed acute primary care, 22.7 percent said they had delayed dental care, and 17.0 percent said they had delayed chronic or routine primary care. For children, 26.3 percent of respondents said they had delayed acute primary care, 23 percent had delayed dental care, and 24.3 percent had delayed chronic or routine primary care.

Needed Policy Steps: Government Must Ensure Health Coverage And Access To Care For Those Displaced By Disasters

To improve the condition of the Katrina IDPs, as well as those displaced by future disasters, Lawry and her coauthors call for federal legislation to ensure health care coverage for IDPs, either through Medicaid extensions or via a special emergency fund for the states. The researchers also call for the temporary use of mobile medical units and other methods of meeting the ongoing health needs of IPDs.

Finally, Lawry and coauthors urge the federal government to fund long-term mental health services for IDPs. Current law mandates that mental health funding connected with disasters be used only for crisis management, and not for long-term treatment. As a result, despite rates of suicide and suicide attempts among IDPs nearly four times higher than the baseline rates for Mississippi, “more than two-thirds of those [IDPs] with major depressive disorder or suicidal ideation had not received mental health services since displacement,” the authors write.

Shehab is a graduate student at the Johns Hopkins University Bloomberg School of Public Health and a guest researcher at the Centers for Disease Control and Prevention. Anastario is a research associate and assistant professor at the Center of Disaster and Humanitarian Assistance Medicine, a part of the Uniformed Services University of the Health Sciences. In addition to her government post, Lawry also directs the Initiative in Global Women’s Health at Brigham and Women’s Hospital and is an associate at the Johns Hopkins Bloomberg School of Public Health.

Health Affairs, published by Project HOPE, is the leading journal of health policy. The peer-reviewed journal appears bimonthly in print with additional online-only papers published weekly as Health Affairs Web Exclusives at www.healthaffairs.org. The full text of each Health Affairs Web Exclusive is available free of charge to all Web site visitors for a two-week period following posting, after which it will switch to pay-per-view for nonsubscribers. Web Exclusives are supported in part by a grant from the Commonwealth Fund.